Healthcare Provider Details

I. General information

NPI: 1205448966
Provider Name (Legal Business Name): CORE BEHAVIOR SKILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5445 GINGER COVE DR APT E
TAMPA FL
33634-7435
US

IV. Provider business mailing address

8635 W HILLSBOROUGH AVE # 315
TAMPA FL
33615-3810
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-7149
  • Fax:
Mailing address:
  • Phone: 786-353-7149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: CARLOS ENRIQUE SILVESTRE
Title or Position: CEO
Credential: BCBA
Phone: 786-316-5692